Pneumonia, an Unusual Initial Presentation of Neonatal Herpes Infection.

Neonatal herpes simplex virus (HSV) infection is a life-threatening infection with high morbidity and mortality rates. Neonatal herpes, most commonly due to HSV type 2, is a multi-system disease; however, initial pulmonary presentation is extremely unusual. We describe an infant presenting with progressive respiratory distress, which was the dominant clinical feature of HSV infection during the first days of life. Sepsis work-up and antibiotic treatment were immediately initiated; however, antiviral treatment was not given until the infant's death. HSV type 1 was isolated in nasopharyngeal and endotracheal aspirates. HSV pneumonia should be considered in a newborn with respiratory deterioration not compatible with common neonatal respiratory diseases.

Green Breast Milk Following Ingestion of Blue-Green Algae: A Case Report.

Breast milk is an excellent nutritional source for newborns, and a change in its color can be alarming to both mother and physician, and may prevent breastfeeding. Different colors of breast milk have been reported such as blood-stained, blue, and bluish-green. We present the first case of green breast milk caused by maternal ingestion of blue-green algae pills immediately before and after delivery. The score on the Naranjo Adverse Drug Reaction Probability Scale was 5, indicating a probable adverse drug reaction. Laboratory analysis yielded no other abnormalities in the milk. The mother stopped taking the supplement, and the milk returned to its normal appearance 3 days later. This report should alert physicians to include supplement intake as part of the anamnesis for new mothers who present with breast milk changes.

Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies.

OBJECTIVE: To determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns. DESIGN: Retrospective cohort. SETTING: Tertiary university-affiliated medical centre. PATIENTS: All newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks' gestation over a 5-year period. EXCLUSION CRITERIA: multiple gestation, maternal hypertensive disorder, diabetes or cholestasis, placental abruption or intrapartum fever (>38°C), small for gestational age (<10th centile) and major congenital or chromosomal anomalies. INTERVENTIONS: None. OUTCOME MEASURES: Admission to the neonatal intensive care unit (NICU), hospital length of stay, 5-min Apgar score, birth trauma, respiratory, neurological, metabolic and infectious morbidities and neonatal mortality. The adverse outcome rate was compared among three groups based on gestational age at birth: post-term (≥42+0 weeks), late term (41+0 to 41+6 weeks) and full term (39+0 to 40+6 weeks). RESULTS: Of the 23 524 eligible neonates, 747 (3.2%) were born post-term, 4632 (19.7%) late term and 18 145 (77.1%) full term. Women in the post-term group versus the late-term group had a significantly higher rate of caesarean section (8.9% vs 5.6%, p<0.001) and operative vaginal delivery (9.6% vs 7.4%, p=0.024). Post-term pregnancy versus full-term pregnancy was associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.8), respiratory morbidity (OR 2.2, 95% CI 1.3 to 3.8) and infectious morbidity (OR 1.88, 95% CI 1.32 to 2.69). Post-term pregnancy versus late-term pregnancy was similarly associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.9), respiratory morbidity (OR 2.7, 95% CI 1.5 to 5.0) and infectious morbidity (OR 1.8, 95% CI 1.2 to 2.7) and with hypoglycaemia (OR 2.6, 95% CI 1.2 to 5.4). Post-term delivery was not associated with neonatal mortality. CONCLUSIONS: Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies.